Asthma

What is asthma?

Asthma is a condition that causes swelling and inflammation inside the airways of the lungs.  This inflammation and swelling is there to a greater or lesser degree all the time in people with asthma. The more inflammation there is the harder it becomes to breathe. People with asthma also have over-sensitive airways, so their airways react to triggers that do not affect other people.  When sufferers come into contact with something that irritates their airways (a trigger), it can cause their airways to narrow. This happens in three ways:

  1. The muscles that surround the airway tightens
  2. The lining of the airway becomes inflamed and starts to swell.
  3. Sticky mucus is produced which can narrow the airways further still.

How common is asthma?

Asthma is very common with over 5 million people in the UK receiving treatment

How do I recognise if I have asthma?

The most common symptoms of asthma are:

  • Coughing  
  • Shortness of breath
  • Chest tightness 
  • Wheeze  
  • Activities are limited by coughing, wheezing, shortness of breath or cough.

As asthma is a variable condition, symptoms may vary depending on the time of day and from season to season.  Not everyone with asthma will experience all of the symptoms described above. Everyone’s asthma is different and triggers for asthma vary between asthmatics. Apart from asthma, there are also other causes for persistent coughing, shortness of breath, chest tightness or wheeze. So if you experience these symptoms; it is important that you make an appointment to see your doctor for advice.

What will trigger my asthma?

It is important to identify what triggers your asthma.  The first part of managing your asthma is avoiding triggers, so that you can reduce unnecessary symptoms. Triggers vary between individuals and individuals may have more than one trigger. The commonest triggers of asthma are:
 
Air pollution
Levels are likely to be higher during hot sunny days or in cities.
 
Allergy

Allergy is one of the commonest triggers and one of the most important.  Allergens (substances that cause an allergic reaction) that trigger asthma include: grass pollen, tree pollen, house dust mites, and pets. Food allergy can be responsible but is less common. It is essential to determine whether allergies trigger your asthma, as reducing the levels of allergen you are exposed to may improve your asthma.

Rhinitis-Colds, flu and chest infection
Most asthma patients also have rhinitis- ask your doctor to check you for this as treatment can improve asthma control. Colds are another common trigger of asthma. Annual flu vaccinations are recommended for all asthmatics.  More severe asthmatics requiring regular steroid tablets should talk to their doctor about also receiving the pneumoccocal vaccination.
 
Emotion
Laughter, excitement, fear or anger can bring on symptoms
 
Exercise
Some people with asthma may develop wheezing, shortness of breath or coughing during or after exercise. This is often a sign that asthma is poorly controlled.  Therefore if you develop symptoms of asthma whilst exercising you should visit your doctor, so that your asthma control can be reviewed.

Medications

Some people with asthma are sensitive to aspirin, ibuprofen, diclofenac and other drugs in the NSAID family.  Other medicines that can sometimes trigger asthma include beta-blockers used to treat heart conditions and glaucoma and certain cold and flu-remedies.  When you are buying medicine at the chemists or when the doctor is prescribing a medicine for you always inform them that you have asthma.
 
Smoking
Smoke contains thousands of chemicals which irritate the lungs.  Most smokers find that their asthma will be worse in a smoky environment.
 
Weather

Changes in temperature or a cold spell can trigger asthma in susceptible individuals. Heavy thunderstorms have been shown to increase the risk of asthma attacks.

How does allergy play a role in asthma?

If you are allergic and are exposed to a particular allergen, (e.g. grass pollen, house dust mite, cat, moulds) it may trigger an asthma attack.  There are two main ways in which allergy contributes to worsening asthma: 

  1.   Allergy itself can produce allergic inflammation in the airways
  2. Exposure to an allergen can trigger an asthma attack

It can be helpful to determine whether allergies do trigger your asthma, as if you can reduce exposure to triggering allergens your asthma may improve and your need for medication may decrease.  Therefore after taking your history, your doctor may perform skin prick tests or blood tests (RAST) for allergen specific IgE to look for antibodies to allergens.  Both skin prick tests and RAST tests have been medically proven to help diagnose allergy.

Can asthma be cured?

There is no cure for asthma but fortunately there are excellent treatments.  With correct management most individuals can enjoy an active lifestyle and carry out day-to-day activities with no symptoms.

Which medicines are available to treat asthma?

Medications to treat asthma can be divided into three groups:

  1. Relievers e.g. Ventolin, Bricanyl These provide relief from asthma symptoms within minutes by relaxing the  muscles that surround the airways.  This allows the airways to open up and it becomes easier to breathe. You should always carry your reliever with you, in case of emergency.   If you require your reliever three or more times a week, it could be a sign that your asthma is not well controlled and you should check with your doctor.

2.   Preventers e.g. Flixotide, Pulmicort, Qvar If you have asthma, you will probably find that your doctor prescribes you a preventer and a reliever inhaler. This is because preventers (unlike relievers) will directly reduce swelling and inflammation in the airways. They will also reduce over-sensitivity in the airways, so exposure to triggers (e.g. cigarette smoke, viral infections, allergens) will be less likely to cause symptoms.   Preventers must be taken every day to be effective.  They will not be effective if used on an ‘as and when’ basis. They do not give quick or immediate relief of symptoms and may take a couple of weeks to work, so do not stop using your preventer if you notice no improvement after the first week.   Most patients find that they need their reliever inhaler less often once they are using a preventer regularly
 
3.   Other treatments. If despite using a regular preventer, your asthma is not well controlled your doctor may  suggest adding in other treatments.
      These include:

  • Long-acting relievers which relax the airway muscles for up to 12 hours
  • Combination inhalers which contain both a steroid preventer and a long-acting reliever
  • Leukotriene receptor antagonists which block one of the inflammatory chemicals released in the airways of asthmatic patients
  • Theophylline which relaxes the airway muscles

How can I tell if my asthma is well controlled?

Signs that your asthma is well controlled include:

  • If you are able to sleep through the night and do not wake up wheezing or coughing or chest tightness or shortness of breath.
  • If you are able to exercise and feel okay both during and afterwards  
  • If you are able to get through the day and your usual activities without developing wheezing or coughing or chest tightness or shortness of breath.  
  • You do not need your reliever inhaler more than three times a week.

How can I manage my asthma effectively?

There are lots of things you can do to improve the management of your asthma:

  • Find a GP with an interest in asthma or a GP who runs an asthma clinic.  
  • Make sure you know what triggers your asthma and avoid these triggers if possible.  
  • Make sure that you own a peak flow meter and know what your peak flow should measure.
  • Know how to use your asthma medications correctly, preferably via a spacer.
  • Most people who experience an asthma attack give a history of gradual worsening of symptoms. So learn to recognise worsening symptoms of asthma. Ask your doctor for a written Asthma Action Plan so you are clear how to manage your asthma.

What should I do in an asthma attack?

  • Sit upright and loosen any tight clothing
  • Take your reliever inhaler (usually blue) immediately
  • If there is no improvement take one puff of your reliever inhaler every minute for five minutes or until symptoms improve
  • If there is no improvement call an ambulance (999)

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